From the Guidelines
Apolipoprotein B (ApoB) is a protein that serves as a similar risk marker to LDL cholesterol and a better index of the adequacy of LDL-lowering therapy, with optimal levels being <80 and <100 mg/dL for subjects with very high or high CVD risk, respectively. Apolipoprotein B (ApoB) is the main apoprotein of atherogenic lipoproteins, and its levels have been frequently measured in outcome studies in parallel with LDL cholesterol 1. The available evidence suggests that ApoB can be substituted for LDL cholesterol in risk assessment, but it does not add further to the risk assessment, and there appears to be less laboratory error in the determination of ApoB than LDL cholesterol, particularly in patients with hypertriglyceridaemia 1. Some key points about ApoB include:
- ApoB is a similar risk marker to LDL cholesterol
- ApoB is a better index of the adequacy of LDL-lowering therapy
- Optimal ApoB levels are <80 and <100 mg/dL for subjects with very high or high CVD risk, respectively
- ApoB measurement is not presently being measured in most laboratories, but it could easily and inexpensively provide standardized measurements 1. ApoB plays a crucial role in the transport of cholesterol and fat in the bloodstream, and high levels of ApoB are associated with an increased risk of cardiovascular disease, as these particles can deposit cholesterol in artery walls, leading to atherosclerosis. ApoB levels can be measured through a blood test, often as part of an advanced lipid panel, and values below 80-100 mg/dL are generally considered optimal for cardiovascular health, especially in people with diabetes, metabolic syndrome, or those with normal LDL cholesterol but elevated triglycerides 1.
From the Research
Definition and Role of Apolipoprotein B
- Apolipoprotein B (ApoB) is a protein that is present in every particle of very low-density lipoprotein, intermediate density lipoprotein, low density lipoprotein, and lipoprotein(a) 2.
- ApoB-containing lipoproteins are widely accepted as the most important causal agents of atherosclerotic cardiovascular disease 3.
- The unique single ApoB per particle ratio makes plasma ApoB concentration a direct measure of the number of circulating atherogenic lipoproteins 2.
Apolipoprotein B as a Biomarker for Atherosclerosis
- ApoB is considered a better proxy to low-density lipoprotein cholesterol for assessing atherosclerotic cardiovascular disease risk, especially in specific subgroups of patients 4.
- ApoB integrates and extends the information from triglycerides and cholesterol, which could simplify and improve care for atherosclerotic cardiovascular disease 2.
- The European Society of Cardiology/European Atherosclerosis Society Guidelines concluded that ApoB was a more accurate measure of cardiovascular risk and a better guide to the adequacy of lipid lowering than low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol 5.
Physiological Mechanisms of Apolipoprotein B
- The number of ApoB particles determines cardiovascular risk, and the concentrations of triglycerides and low-density lipoprotein cholesterol may obscure this relation 6.
- The mechanisms that govern the number of very low-density lipoprotein and low-density lipoprotein particles are responsible for the discordance between the mass of cholesterol within ApoB particles and the number of ApoB particles 6.
- ApoB is proposed as a better marker of cardiovascular risk than low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol due to its ability to measure the total number of atherogenic lipoproteins 4, 6.